Disclaimer: Flare Capital Companions is an investor in Aetion, Cohere Well being, HealthVerity, Inbound Well being, Iora Well being and VivorCare. See the broader Flare presentation right here.
That is half one in every of a two-part sequence on innovation in most cancers care supply. Partly one, we are going to talk about the complexity of end-to-end most cancers care administration, the unmet wants and the way some rising digital well being gamers tackle these issues. Partly two, we are going to spotlight the “subsequent wave” and rising tendencies of digital health-enabled most cancers care supply.
It is no secret: Most cancers is patently advanced.
Sufferers usually wrestle to know the complexities of the U.S. well being system, and this confusion is usually amplified after a affected person receives a most cancers prognosis. The Worldwide Company for Analysis on Most cancers forecasts the variety of new most cancers instances worldwide will attain greater than 29 million by 2040 in contrast with simply over 18 million in 2018. As therapy protocols advance and other people stay longer, typically conquering a number of cancers of their lifetime, the right storm of power illness will rise and problem our healthcare system in quite a lot of methods.
With this enhance within the variety of most cancers survivors, organizations have to be ready to deal with the following impacts of long-term toxicities, recurrence of most cancers, infertility points, cardiovascular side-effects and psychological aftereffects.
Whereas analysis reveals most cancers has surpassed coronary heart illness because the primary explanation for loss of life in some high-income counties within the U.S., we’ve got not seen the identical progress and adoption of digital platforms for most cancers within the ways in which we have seen for different power illnesses similar to diabetes, musculoskeletal illness and power kidney illness. So why is not extra innovation occurring for most cancers care supply?
We search to reply this query by understanding the important thing challenges opposing value-based most cancers care, and unbundling a very powerful facets of care supply, to determine the important thing tendencies that may affect innovation for most cancers care within the subsequent decade.
Whereas tailwinds from COVID-19 and healthcare consumerism have pushed record-setting quantities of fundraising for early-stage digital well being startups during the last three years, main challenges exist for most cancers care supply that makes this space a very troublesome area to disrupt.
One purpose progressive care fashions similar to value-based and home-based care haven’t seen faster adoption lies within the problem related to integrating, and sometimes reintegrating, providers across the care workforce. As we proceed to innovate for most cancers care supply, organizations have to be considerate concerning the reintegration of care (e.g., level options). As well as, new options should empower the care groups to convey the best high quality instruments whereas additionally elevating affected person and supplier satisfaction — a tricky steadiness to strike.
In talking with Aaron Gerber, CEO and cofounder of Reimagine Care, he famous the combination of correct instruments is not the one problem.
“When taking a look at specialty medicine, we have to contemplate each complexity [to administer the drug] and margin it generates for the healthcare system. We will then take a phased strategy that begins with the decrease complexity, decrease margin medicine and increase over time, however solely after demonstrating success and elevated consolation with the affected person’s main oncology workforce,” he stated. “Carried out effectively, this will increase affected person and supplier expertise whereas offering the chance to ship very high-quality dwelling and digital care to sufferers.”
Level-solution fatigue for payers and suppliers, specialty drug buying and the danger of the perceived adjustments’ impression on profitability for current enterprise fashions usually stifle collaboration throughout stakeholders. Capital depth related to growing these strong options, usually tied to platform growth and the hiring prices for expert clinicians and care suppliers, stays a priority for early traders as platforms scale. Different challenges embrace the necessity to tightly combine surgical care into the answer to deal with larger acuity affected person populations. Add to that the widening disparity of look after underserved and rural populations, historically served by group suppliers, and also you rapidly end up in a discipline of competing incentives and lagging enterprise fashions.
Key parts of the most cancers care continuum have been highlighted under to section an in any other case dastardly set of providers rendered throughout the affected person journey. Features of the journey span the earliest stage of a affected person’s journey (similar to discount in solar publicity and tobacco use), to superior care and end-of-life care planning.
Whereas the best alternative to disrupt conventional enterprise fashions stays to be seen for most cancers care, startups have more and more tried to enter completely different components of the care continuum solely to run right into a slew of regulatory, incentive and integration hurdles imposed by incumbents within the area. As well as, the service-based facets similar to prognosis, therapy, survivorship and end-of-life care require sturdy coordination round different facets similar to funds, schooling and household/caregiver help planning.
Innovation is starting to take form in several methods. Startups proceed to handle unmet wants by filling care gaps and supplementing current therapy types. Nevertheless, providers which have historically been non-revenue-generating appear to be a typical theme the place suppliers do not traditionally have the means to fund these initiatives, and payers are nonetheless too early in contracting for risk-based most cancers fashions. Whether or not startups can generate sustainable income within the short-term and display worth to stakeholders similar to well being programs and payers stays an open query.
Regardless of conserving facets of the biopharma and therapeutics area separate (we acknowledge there’s a a lot broader biotechnology and therapeutics marketplace for oncology, and quite a few firms are driving innovation ahead), essentially the most distinguished startup exercise for care supply has been in diagnostic providers, therapy coordination and danger enablement.
On the sooner aspect of the affected person continuum, prevention and danger discount options proceed to face a robust headwind as organizations attempt to combine preventative and screening-based providers with their acute care counterparts. Balancing the fee-for-service nature of acute care supply with value-based preventative providers can be troublesome; aligning incentives can be important. We anticipate survivorship providers (most notably, group and vitamin providers) will proceed to combine extra tightly upstream with facets of acute care supply and recurrence prevention (e.g., screening, prognosis).
On this market map, we spotlight a number of startups innovating throughout key classes. (See the broader Flare presentation right here.)
Remedy: Leveraging information, care coordination and affected person help instruments to enhance choice making
Remedy is on the core of most cancers care supply, and we see varied options being constructed throughout the class. A lot of the current most cancers therapy plans include three core providers: surgical intervention, systemic remedy and radiation therapy. Relying on the stage and presenting most cancers, surgical intervention is usually the primal type of therapy for early-stage diagnoses, and it is usually complemented or augmented with each systemic (chemo, hormone and immunotherapy) and radiation remedy.
Startups, nevertheless, are addressing challenges round therapy pathways in several methods, specializing in issues similar to navigation, coordination, therapy suggestions (for an knowledgeable shopper) and affected person help. We’ve additionally referred to as out dwelling care, given the rise of at-home therapy choices (similar to dwelling infusion remedy and lab assessments), though we acknowledge many facets of dwelling care in oncology fall underneath different classes similar to screening and prognosis.
The trade has additionally seen a drastic enhance within the availability of knowledge (e.g., claims, EMR, diagnostics, imaging) during the last 20 years to higher handle most cancers sufferers. Along with Flatiron Well being, there have been varied information platforms, marketplaces (HealthVerity, Graphite Well being) and analytics-ready information enablers (Mendel, Aetion) rising to make information extra accessible to researchers and clinicians. Nevertheless, many challenges nonetheless exist for clinicians managing their sufferers by way of an evidence-based strategy.
“Well being programs right this moment are sometimes not set as much as make selections based mostly on real-world information. Medical trial information and different revealed information is available, however organizations are starting to make the shift from the established order of revealed proof (expertise-driven) to real-world proof (data-driven strategy) in scientific follow,” stated Matt Bettonville, who leads Oncology Enterprise Investing at Emerson Collective.
Instruments that use real-world proof (RWE) to assist suppliers reply questions and supply clinical-decision help in a well timed method, each standalone firms (e.g, Atropos Well being) or these internally developed by well being programs and tutorial medical facilities, are anticipated to emerge within the coming years to drive extra personalised therapy protocols.
The primary space we unbundle throughout the therapy class is navigation.
As know-how continues to embed itself throughout the most cancers care continuum, extra alternatives have arisen for know-how to bridge the hole between current therapy regimes and in the end present extra holistic and personalised ranges of most cancers care. Even when core remedies aren’t basically altering (e.g., surgical intervention), sufferers and physicians can fine-tune facets of care to the affected person utilizing information and automation to help the administration of signs, unwanted effects, food regimen monitoring, appointments, affected person funds and general coordination of in any other case disparate facets of care.
Navigation providers are in some ways the bedrock for sufferers navigating the complexities of care, and these providers play a important function to handle affected person’s largely unmet wants. Gamers similar to Jasper Well being supply digital care administration instruments and a library of sources to help sufferers with all the things from dealing with unwanted effects to monetary planning.
Care coordination is a sizeable sub-category inside therapy that features choice help instruments to help physicians with managing affected person wants and, in concept, scale back administrative burden. One instance, Preveta, is a care coordination platform that takes illness protocols and interprets them into personalised care navigation workflows. By way of automated dashboards and refined information seize, programs purpose to allow the clinician to seize further affected person information between visits. In flip, the software program can assist assess the information and get it again into the fingers of the medical doctors rapidly to enhance therapy.
One other aspect of care coordination consists of digital symptom administration, which sits on the intersection of distant monitoring instruments for patient-reported outcomes (e.g., Vinehealth, Reprosent) and proactive administration of signs by way of companion apps. As these startups scale, it turns into more and more vital to display improved affected person outcomes and ROI for purchasers (payers, suppliers) adopting the software program. Participating payers early additionally turns into an vital issue for organizations looking for to allow danger and handle bundled providers.
Alternatively, the route of accumulating and aggregating affected person information by way of digital affected person help instruments can become a pretty alternative for pharmaceutical firms that search to faucet into distinctive affected person datapoints (similar to social determinants of well being), which can assist inform drug adoption and adherence, scientific trial enablement and a number of facets of drug growth.
Remedy Suggestions and Affected person Assist
As affected person information turns into extra commoditized, and clinicians are inundated with the sheer quantity of knowledge and analysis publications that aren’t humanly doable to course of, scientific choice help (CDS) instruments and next-generation analytics firms that may present the “so-what” will play a central function in therapy suggestion and affected person administration.
Whereas Merative (previously IBM Watson Well being) and different CDS distributors primarily depend on publicly obtainable pointers and analysis publications, a brand new class of digital well being startups augments current pointers with real-world information (RWD) and real-world proof (RWE) to supply a extra data-driven manner of treating most cancers sufferers.
“You want RWE and analytics and choice help that oncologists can get behind,” stated Dan McCarthy, CEO of New Century Well being and president of Evolent Well being.
Gamers similar to Atropos Well being present options that assist physicians reply beforehand unanswered scientific questions utilizing real-world scientific and administrative information in a well timed method. Digital well being firms similar to Outcomes4Me and Ciitizen emerge and attempt to help most cancers sufferers of their journey to discovering the appropriate therapy choices, and acceptable scientific trials, by way of schooling and affected person help.
Strains proceed to blur as supplier organizations search to create touchpoints earlier and earlier in a affected person’s journey by establishing digital entrance doorways, and alternatively, pharmaceutical firms search to realize entry to extra longitudinal information to help decision-making.
Dwelling-Primarily based Most cancers Care
The shift to home-based look after most cancers has been in growth for over a decade, however the current adjustments within the regulatory setting have enabled sure types of remedy to be administered within the consolation of a affected person’s dwelling. Key adjustments, spawned partially by COVID-19, embrace the elevated adoption and want for care administered within the dwelling, and growing pressures on the system on account of rising prices in key areas of spend (together with musculoskeletal, most cancers and renal).
Gamers like Reimagine Care and Karkonos are tackling dwelling infusions, lab attracts and digital visits with the purpose of constructing care extra reasonably priced and extra accessible. Whereas others similar to Inbound Well being and Medically Dwelling are enabling well being programs to manage hospital-at-home for medium- and high-acuity sufferers, though the prime focus could not all the time be solely on most cancers sufferers.
Questions stay across the degree of involvement that well being programs and payers may have within the growth of dwelling well being generally. Whereas it’s nonetheless unclear precisely how and the place well being programs and AMCs will combine into the broader ecosystem, startups are starting to display (and justify) a key understanding of price when growing these home-based capabilities for most cancers.
As startups proceed to make progress in sure areas of the therapy pathway, we count on to see increasingly well being programs and payers looking for partnerships with outdoors organizations as they increase their hospital-at-home and home-based providers.
Enablement and Danger-Bearing Entities: An effort to basically shift the enterprise mannequin of most cancers care to worth
Previously, oncologists have been fairly nervous about taking dangers, even professionally, on account of anxiousness round specialty drug prices. For many medical teams, the know-how wants are additionally too daunting as too many level options are sometimes wanted to correctly handle populations. Payers are additionally nonetheless within the state of transitioning, as disagreement across the degree of inclusion for specialty drug prices usually ends in a rate-limiting step for contracting.
Whereas challenges persist, current tendencies have enabled increasingly oncology teams to start transferring towards danger. As Shawn Morris, CEO of Privia Well being, stated, “When requested concerning the risk by traders and analysts, there are just a few specialties which can be excessive quantity and might underwrite the danger from an actuarial standpoint in Medicare —orthopedics, GI, urology, ophthalmology and oncology. The success of transferring into value-based preparations and danger relies on correct alignment with physicians and payers and having the required instruments, expertise and know-how (information) to handle danger.”
Alternatives are increasing for startups and oncology teams to start out with skilled capitation and in the end transfer upstream. These preparations are principally seen within the Medicare Benefit area, and as organizations proceed to display improved outcomes, industrial alternatives could quickly be on the horizon.
“Success in bearing danger is feasible when you design the appropriate methodology,” Robin Shah, CEO and cofounder of Thyme Care, stated. “This requires a deep understanding of the affected person past their scientific components, and to construct that understanding it is advisable develop trusted relationships with members. With out these relationships in place, you received’t be capable of affect habits change.”
Completely different Approaches
We see innovation in danger enablement taking many types. Whether or not it’s firms similar to Transcarent (e.g., not too long ago introduced Transcarent Oncology Care) looking for to overtake the employer self-insured enterprise or firms taking a data-driven strategy to enhancing broader affected person care pathways, specializing in facets similar to tumor boards, many enablement platforms are rising that drive collaboration throughout sufferers, suppliers and payers. Different gamers, similar to Azra AI, are utilizing synthetic intelligence to interpret information in real-time to tell prognosis by way of care administration. Thyme Care provides a nursing-led platform that’s geared up with information and analytics to proactively help most cancers sufferers’ choice making and coordination all through the method. Cohere Well being appears to align scientific and monetary selections holistically throughout an oncology affected person’s care journey, enabling higher collaboration and decision-making in the direction of high-value care.
If arrange appropriately, enablement platforms have the potential to supply a brand new approach to navigate members to high-quality, low-cost care, even when meaning transferring them to the very best and least costly facility in a patient-friendly manner. Current enterprise fashions have an vital cost-focused distinction that’s basically completely different in some ways in contrast with the normal, revenue-focused actions launched by giant most cancers facilities within the early 2010s (e.g., CTCA collaborates to supply free air transportation for most cancers sufferers) that have been usually established to develop an current supplier’s footprint.
In abstract, a elementary shift from historic most cancers care enterprise fashions should happen so digital well being innovation may be adopted extra rapidly. With the emergence of re-bundling applied sciences and tech-enabled providers, we count on the progress of risk-bearing and risk-enablement platforms to be a key side for accelerating the evolution of the most cancers enterprise mannequin.
Screening and Prognosis: Tech developments and home-enabled providers producing distinctive entry factors
Early most cancers screening and prognosis can usually be the distinction between life and loss of life for most cancers sufferers. In keeping with the American Most cancers Society, the 5-year relative survival charge between two colon most cancers sufferers, one on the “localized” SEER stage (91%) and one on the “distant” SEER stage (14%), is staggering. The significance of early screening and detection of most cancers is well-established and well-known to clinicians and sufferers alike.
Over the previous 20 years, exceptional enhancements in applied sciences have allowed physicians to seek out most cancers at an early stage, lengthy earlier than signs seem. From higher imaging procedures to varied breakthrough diagnostic assessments (e.g., liquid biopsy, single-cell genomic testing, multi-OMICs), the flexibility to display screen and diagnose cancers has taken an enormous leap ahead.
Important enhancements in sequencing know-how and value led to the rise of firms like GRAIL, which pitches a multi-cancer early detection take a look at that may display screen over 50 kinds of most cancers by way of a single blood draw for roughly $1,000. Along with enhancing novel screening and diagnostic assessments, private and non-private sectors have additionally performed their fair proportion of elevating most cancers screening consciousness and enhancing entry. From varied most cancers screening campaigns from the non-public sector and non-profits to CMS making a number of most cancers screening (e.g., breast most cancers, colorectal most cancers) a part of the Medicare Half C Star Rankings measurement, screening and detection play a entrance and heart function on this evolution of most cancers care.
Whereas vital technological and coverage enhancements have been made, many unmet wants nonetheless exist. Limitations embrace transportation to diagnostic websites, lengthy wait instances for specialists and entry to genetic counselors. Digital well being innovators can play a vital function in addressing these unmet wants. From a affected person entry to screening standpoint, we’ve got seen non-invasive, home-based diagnostic assessments, similar to Cologuard, which can be getting used and promoted by payers over the previous decade (e.g., Humana to cowl Cologuard for colorectal most cancers screening).
Revolutionary digital well being and home-based diagnostics firms (e.g., EverlyWell) have emerged over the previous decade to enhance entry to diagnostic assessments that may be performed at point-of-care or with samples collected at dwelling. It isn’t inconceivable that platforms like EverlyWell will transfer past well being and wellness assessments and use their consumer base to enhance most cancers screening and detection. Different rising gamers that may dramatically scale back entry obstacles embrace dwelling phlebotomy firms (e.g., GetLabs, Sprinter Well being) that might make the blood draw extra accessible. They will additionally help in ongoing affected person administration for these sufferers who’re in the end identified with most cancers and could possibly be enrolled in home-based most cancers administration and scientific trials.
Educating sufferers on the impression of scientific therapy and way of life change stays a largely unmet want, no matter affected person acuity or circumstance. Most cancers facilities have taken a proactive step during the last 20 years to supply schooling instruments and providers to equip the sufferers with extra info (together with the rise of tech-enabled directories e.g., Mayo Clinic’s on-line sources and library), however outcomes can usually be described as “info overload,” inflicting sufferers to really feel overwhelmed.
Systematic evaluations for superior most cancers sufferers and casual caregivers (e.g., partner, relations) have three widespread areas of unmet want: psychological, bodily and healthcare providers info.
A number of the largest instructional gaps for sufferers lie in the advantages and unwanted effects of therapy in addition to way of life adjustments, each after the preliminary prognosis and when transitioning from energetic therapy to survivorship. Schooling and care coordination startups are beginning to emerge that empower their sufferers with instruments similar to automated aspect impact help (e.g., Ankr) that may help in ongoing, asynchronous affected person administration to supply vital power administration and inhabitants well being information.
Survivorship: An emergence of digital-hybrid communities and vitamin help to assist with a affected person’s altering way of life
Sufferers will want extra individualized help as therapy and affected person administration develop into extra focused and personalised. In right this moment’s social media-connected world, most cancers sufferers search to narrate to sufferers like them. First-generation, patient-focused social networking websites like PatientsLikeMe emerged within the 2000s, whereas new affected person communities similar to Encourage and That is Residing With Most cancers have emerged to supply group help and steering on therapy choices in more moderen years.
Along with peer help networks, expert-guided digital clinics, similar to VivorCare, have emerged to supply personalized help and tailor-made packages that assist most cancers survivors handle their care outdoors the hospital setting, beginning with packages designed for psychological well being. Vitamin-as-medicine continues to take off, and whereas many startups are specializing in gastrointestinal care (in lots of instances, beginning with IBD and IBS sufferers), startups are rising (Savor Vitamin, Season Well being) which can be effectively positioned to fill the hole for oncology sufferers with food-as-medicine, much like how these gamers are managing sufferers with power illnesses similar to diabetes.
In regards to the Authors: Ian Chiang is a accomplice at Flare Capital Companions, a healthcare know-how and services-focused enterprise capital agency. Previous to becoming a member of Flare, he was the SVP of product and innovation and a founding member of CareAllies, Cigna’s household of multi-payer supplier providers, inhabitants well being administration, value-based care enablement and home-based care companies. Beforehand, he was a digital well being entrepreneur and a former administration advisor at McKinsey & Firm.
Jonathon George is an MBA candidate at Kellogg Faculty of Administration and a Flare Capital Scholar. Whereas at Kellogg, he interned on the Mayo Clinic of their Oncology Division and at OCA Ventures as an investor. Beforehand, he was a administration advisor at Chartis targeted on well being programs and providers.
A particular because of Aaron Gerber, Dan McCarthy, Matt Bettonville, Ryan Langdale, Robin Shah, Shawn Morris and numerous others for offering their time and insights by way of a number of interviews. The workforce at Flare interviewed 20+ executives, founders, traders, sufferers and leaders from throughout the nation on matters associated to oncology, innovation and tech-enabled providers for most cancers care supply. This text wouldn’t be doable with out their help.